"If you have to worry about whether you have food for dinner that evening, and for the rent on Friday, you have little space to think about anything else. Such stress can permanently affect the development of your children".
There's the moral argument for increasing nurses' pay - very strong. Then, there's the economic argument. Want to fill all those vacant nurses' posts? Pay a decent wage, and relieve the pressures of understaffed services.
Confirmed by
@TheMarmotReview
: life expectancy stops improving, has actually fallen for poorest women, health inequalities widen and health deteriorates
#Marmot2020
supported by
@HealthFdn
The PM said in Parliament that child poverty had gone down since 2010. And cited a specific number. He was wrong. Child poverty went up. Is there an obligation for him to correct the record in Parliament? Not to mention a longer term obligation to get the numbers right.
UK 2023: “Due to the soaring cost of infant formula, families experiencing food poverty are being forced to resort to unsafe feeding practices, including stretching out time between feeds and giving their babies food which is not suitable, like porridge."
If you are rich in the UK, you are almost as well off as a rich Norwegian. If you are poor in the UK, your income is way behind the bottom 5% and 10% in Norway. Brilliantly presented by
@jburnmurdoch
NEW: income inequality in US & UK is so wide that while the richest are very well off, the poorest have a worse standard of living than the poorest in countries like Slovenia
Essentially, US & UK are poor societies with some very rich people.
A thread:
Moving to relax lockdown does NOT appear to be based on best scientific advice. What's going on? When government does things they think are unpopular, they say "it's the science." When they want to do it, they ignore the science.
Covid-19 spreading too fast to lift lockdown in England. Agree with John & clear science advice. TTI has to be in place, fully working, capable dealing any surge immediately, locally responsive, rapid results & infection rates have to be lower. And trusted
Both Conservatives and Labour put high priority on economic growth. I would rather see growth and reduction in inequalities in the height of five-year-old children. That way we will know that we have an economy that is really delivering for the health and wellbeing of all.
Essentials of life include whatever is necessary to take your place in public without shame. Having agency, a sense of self-worth, and participating in networks of family and friends. Lack of income threatens these and damages health.
The situation in the UK is deeply concerning. Health is declining and health inequalities are widening. This is not the case with other European countries. The UK's rankings have gone down since 2014. What a tragic waste of lives
@ucl
@bmj_latest
Open letter in
@BMJ_latest
to UK party leaders by
@MichaelMarmot
says not only is health the foremost concern of individuals, communities and businesses, health is also an indicator of how well a nation is performing
Declaring war on the poor. In what universe is this anything other than immoral? I have been citing figures like these. Yet again, scarcely can I believe that society would reduce education spending at all, let alone reduce it more for disadvantaged children.
Schools serving disadvantaged children have seen larger funding cuts.
The most deprived fifth of secondary schools saw spending per pupil fall by 12% in real terms between 2010 and 2021, compared with 5% for the least deprived fifth.
Read the report
"Of council homes sold off under Right to Buy, 40 per cent have been rented out by private landlords, many to social tenants with landlords’ profits subsidised by the state. It has been a huge transfer of wealth from public to private — a levelling down."
Society and the slow burn of inequality. The pandemic exposes the underlying inequalities in society that lead to the injustice of health inequalities. My essay in
@TheLancet
The Prime Minister says: we have reduced child poverty by hundreds of thousands. Please look at this graph of destitution. Most important is the problem - the steep rise in destitution - but also important is trying to say that it doesn't exist.
Health inequalities? Asked the US. Too political. We’ll call them disparities. Much blander. Now the UK is going down the same route. Once again the UK is trying to abolish health inequalities with the Thesaurus. Easier than creating a fairer society.
So apparently “health inequalities” and “public health” disappear along with PHE - not for me and every Director of Public Health
#HealthInequalities
#Publichealth
| The BMJ
The IMF is against trickle down! "We find that increasing the income share of the poor and the middle class actually increases growth while a rising income share of the top 20 percent results in lower growth—that is, when the rich get richer, benefits do not trickle down."
Evidence from around the world shows health is a good measure of social and economic progress: if society is flourishing, health tends to flourish; health stops improving, society has stopped improving
#Marmot2020
@TheMarmotReview
supported by
@HealthFdn
In what moral universe can this be the right thing to do: the lower the life expectancy of a local area in 2010-12, the greater the cuts to government funding in the subsequent years. Was this a deliberate policy to increase health inequalities?
New
@marmotihe
report: 3/9 English regions showed increases in inequalities in life expectancy for men NE, Yorkshire & Humber & East of England)
@MichaelMarmot
@UCL
Creating the conditions for ill health by denying minimum income for a healthy life. It is government policy that people who need benefits, Universal Credit, will have only 70% of the money they need to live healthily.
From April, Universal Credit will be set at £85 a week for a single adult, but there’s a significant gap between this and living costs. Our research shows that in order to cover the essentials, it must be increased to at least £120 a week.
Welcome to one of Britain's most popular tourist attractions, Michael Marmot's Leaning Tower of Credibility. Thrill to the sight of Michael giving opinions in the shadow of doom. Gasp as he reaches for the Olbas Oil and risks being buried alive. National Trust members half-price.
.
@MichaelMarmot
tells
@ShaunLintern
the evidence show that people don't fall into poverty because of "poor choices" they fall into "poor choices" because of poverty. If we solve the poverty problem, people will make better choices.
#Healthwatch2020
The NHS was highly rated in 2009, with high satisfaction levels, and relatively small numbers waiting for treatment. It has got steadily worse since 2010. It needs more money AND action on the social determinants of health.
New campaign launched today to persuade next Government to commit to reducing health inequalities. New data reinforces the public care about the nation's health. Sign petition at to encourage parliamentary candidates to promote health equity.
When the head of the IMF says that inequality has gone too far, and calls for progressive taxation, everyone should take notice. IMF boss says raise taxes on the rich to tackle inequality
One might have hoped... There was a question to the PM. There was a debate in Parliament about
#Marmot2020
. And Covid-19 has amplified the inequalities that were set out in my report.
Bit surprised that a Govt Minister for Equalities hasn't heard of the Marmot Review, but happy to provide details in a follow up letter. Hopefully Govt can adopt some of its vitally important recommendations to address some of the dreadful inequalities exposed by
#coronavirus
.
Remember, again, inflation may be down, but prices are much higher than they were 3 years ago. Prices are not coming down. They are rising more slowly.
The big shift in prices has come via a huge rise in the relative cost of essentials.
Energy is up by 90% and food up by 31%, compared with overall prices rising 22%.
Importantly, while *inflation* is falling, high prices will be with us for the foreseeable future.
Inequalities in mortality from
#COVID19
- the social gradient - are similar to inequalities in mortality from all causes, suggesting that the the general causes of health inequalities as laid out in
#Marmot2020
apply to COVID19 plus some extra in more deprived areas.
The mortality rate of deaths involving
#COVID19
in the most deprived areas of England was more than double that in the least deprived areas:
▪️ most deprived: 128.3 deaths per 100,000 population
▪️ least deprived: 58.8 deaths per 100,000 population
Launching today, new
@MarmotIHE
report warns the UK must build back fairer from
#COVID19
pandemic – or risk a generation of children and young people experiencing its health impacts throughout their lives. Read more:
#BuildBackFairer
@HealthFdn
Basic error. You have one problem - inadequate funding of the health service, and widespread staff dissatisfaction. You then propose a bad solution, limiting strike action. Now you have two problems.
There are big inequalities in loneliness - lower income, greater frequency of loneliness. And the remedy? Not improve social conditions, take a pill. Really?
Lower taxes? Really? What do you want to achieve? Greater child poverty? Even bigger reductions in spending on education? More regressive cuts to local government? Further immiseration of public sector workers? Worse life for people on welfare?
"For him to say there is 'no connection whatsoever between austerity and the unequal impact of the pandemic on disadvantaged communities’ is quite staggering". Our President
@martinmckee
responding to George Osborne's appearance today at the Covid Inquiry.
New
@marmotihe
analysis confirms since 2010 central government spending cuts to local authorities were highest in areas with lower life expectancy and more health inequalities, further harming health in these places
@MichaeMarmot
@UCL
Social determinants of health ... and crime. People can't afford to eat. It means relying on charity or, increasingly, on stolen food. How about remembering: tough on the causes of crime.
Coronavirus and inequalities. Here's the evidence that low and middle income families will be severely hit by a reduction in income if workplaces shut, they have to take time off sick or need money to respond to the crisis. It will add to their other problems
#Marmot2020
Colleagues, the message is getting through. This from
@guardian
editorial: “Public health is all about social determinants. In other words, poverty, inequality and the risk factors linked to both”. Now, if one or two other papers...
Austerity is correlated with slower improvements in mortality in high-income countries. In case you missed it, this analysis from November 2022 provides evidence that the architects of austerity, no doubt, will ignore.
Prevention of mental illness is possible and requires action on social determinants of health
#SDH
Congrats to
@guardian
for drawing attention to this. It is a key part of health equity.
A decade of austerity takes its toll on deterioriating social determinants
@TheMarmotReview
to release new evidence on health inequalities on 25 February
#Marmot2020
The more deprived the area of residence, the higher the mortality. True for both all cause mortality and for COVID-19 mortality
@MichaelMarmot
@RCPLondon
📊
#IFSSatStat
: Current spending plans imply real-terms cuts to the day-to-day budgets of ‘unprotected’ public service departments like local government, further education, HMRC, courts and prisons of more than 3% per year, posing major challenges for the affected services.
Destitution, including lack of food, damages health. It also erodes security which is also crucial for health. Food insecurity is one specific aspect of general insecurity. The result is health inequality.
In the decade 2010 on, government policy made poor people's lives harder, with little improvement for those in the middle. It is hardly a surprise that health inequalities increased and life expectancy for people in the most deprived areas went down.
Interesting. there are fewer DVTs among recipients of the vaccine than you would expect by chance. David Spiegelhalter
@d_spiegel
patiently spells it out.
Council tax is regressive. More so than income tax or national insurance. So what does the government consider: reducing national insurance and, in effect, force council tax to rise. Poorer people will then pay for council services rather than richer. Inequality rises. Again.
What came out very loud and clear at this nursery I visited was a message of hope. Investing in good early child development is likely to lead to better health; and to greater productivity and a more skilled, more educated workforce. And a better, more socially cohesive country.
Removing the two-child benefit cap will benefit 1.6m of Britain's poorest children. Nurseries improving parental outcomes and childhood outcomes are "terrific" explains
@michaelmarmot
to
@RSheikh26
for BBC Panorama
The government, of course, thinks that healthy eating is a matter of individual responsibility. If so, why have obesity rates gone up? And why increased inequality in childhood obesity? A food strategy needs to deal with inequalities in healthy eating.
Real wages in 2024 forecast to be lower than in 2006. Remember: we were told repeatedly from 2010 to the present that austerity was solving problems of the economy. It certainly was not leading to pay growth.
But while a return to real pay growth is encouraging, it would still mean workers going into a late 2024 election with real wages lower than they were in 2006....
Increasing poverty, COVID, cost of living are driving up need for: child services, adult social care, homelessness and special educational needs and disability. Council budgets have been cut by 40% - the greater the deprivation the steeper the cut.
Austerity was dramatically regressive. In
#Marmot2020
we did the analysis by deprivation. The most deprived 20% of local authorities had a 32% reduction in spending. The least deprived 20% had a 16% reduction. We went into the pandemic I’ll-prepared.
When I was asked on the
@BBC
to comment on the high Covid mortality in BAME groups, and the advice to wash hands, my response was structural racism. But what should we do tomorrow? Tomorrow we should address structural racism. I repeated it several times evening and morning.
Everybody is waiting for
@MichaelMarmot
to say the words "structural racism" or "power" and somehow the commentary keeps missing it out. Maybe next time eh
My comment on the report: "We used to think of the combination of undernutrition and obesity as a feature of low and middle income countries. We are now seeing it in Britain in 2024".
📢 Our latest report highlights the disconcerting deterioration in children's health.
📏 Height of 5 year-olds falling since 2013
🩺 Obesity among 10-11 year-olds up 30%
💉 Type 2 diabetes among under 25s up 22%
Read more: ➡️
@jamieoliver
A huge congratulations to Sir
@MichaelMarmot
on winning the Outstanding Contribution to Health Award and thank you for your work on reducing inequality in healthcare
#TheBMJAwards
Exposing the fault lines in society. Prince and pauper may be infected in the early stages, but as the pandemic proceeds, social distancing reveals inequalities. That's what the data show.
In cities across the U.S., many lower-income workers continue to move around, while those who make more money are staying home and limiting their exposure to the coronavirus, according to smartphone location data analyzed by The New York Times
Pleased to be on that list of public health achievements. Would be even more pleased to see more. action on health inequalities. Our Ten Years On report will be published on 25 Feb, 2020
Read this whole thread by
@RichardJMurphy
But look at this simple point. The government can afford public sector pay increases at a time of inflation because inflation increases government revenues. Pay negotiation is what it sounds - negotiation.
Third, this is completely affordable. The reason is staring us in the face. Inflation does, by itself, pay for these pay rises. The simple fact is that if there is 10% price inflation and 10% wage inflation then the revenues from the three big taxes go up by at least 10% as well.
Since 2019 patient care has been interrupted by a staggering 27,545 incidents caused by fires, leaks & crumbling infrastructure.
One hospital had 40 leaks of raw sewage.
Far from building 40 "new" hospitals, the govt is destroying the ones we have with capital cuts.
Shameful.
In the face of this deterioration in child health, the PM and his Chancellor are thinking about reducing public expenditure further after removing national insurance.
Public services have been savaged by austerity.
@TheIFS
reports that further cuts are planned. Can the Chancellor really be planning tax cuts? If so, say out loud what is being given up in order to fund increases in income for those who pay tax.
It is wrong to think that the public health and economic success are in competition.
@globalhlthtwit
makes the point again: the bigger the pandemic toll, the worse the economic hit.
It seems odd that the countries who failed to tackle the pandemic effectively, which the Barrington people want, suffered the biggest economic hit. (3)
We emphasised in
#Marmot2020
that health follows the social gradient - the more deprived the worse the health. If serious about levelling up, we must address the gradient AND reduce poverty.
#sdoh
to combat the health effects of inequality and poverty.
Infant and child mortality are especially sensitive to deprivation. It implies that the effects of deprivation can be, and should be, prevented to the benefit of all our children.
Look at real wages and ask if the economic policies pursued after 2010 delivered. They did not. Was that supposed to be the justification for austerity with all the damage that it did.
🚘 The UK is in the slow lane 🚘
This morning's disappointing GDP data, follows on from productivity which has been flatlining since 2008.
Productivity stagnation = wage stagnation.
Av. wages are £14,400 below pre-financial crisis trend ⤵️
Shocking new analysis by
@MarmotIHE
for
@friends_earth
finds 9.6 million UK households are living in heat-leaking, poorly insulated homes and have incomes below the minimum required for an acceptable standard of living
@UCL
What can be more rewarding than publishing your first book and holding it in your hands? Answer: your son
@AndreMarmot
publishing his first book. The definitive book on the explosion of British Jazz
A common question: what can we, in health care, do about the social determinants of health. The answer in this report: a great deal. Health care organisations can be active partners to act on social determinants to prevent illness and reduce inequalities.
A report I wrote with
@DrDominiqueAllw
&
@Mimi_Malhotra
for
@UCLPartners
is out today - showing that hospitals have an important role tackling the social determinants of health.
Four inspiring case studies show us not only why this is important, but how it can be done...
The misery of housing rental. English monthly wage about £2,700 a month. Average rental £1276 a month. In London, £2035. No wonder there is widespread food insecurity and cold homes. Mr Micawber’s budget.
The poor in the UK are doing particularly badly from inflation. The cost of living increase from higher energy prices is steepest for the poorest 20% in the UK compared to any European country, except Estonia. Will the new government address this inequality?
The cost of living crisis hits hardest the poorest households, yet the difference across European countries is vast. Estonia is a massive outlier, even compared to the other Baltic countries.
Proud to vote for this groundbreaking legislation, making Scotland the first country in the world to provide free period products for all who need them. An important policy for women and girls. Well done to
@MonicaLennon7
@ClydesdAileen
and all who worked to make it happen
The NHS IS (!) over-stretched and has been doing such valiant work before and throughout the pandemic. It is even more vital that we address the social determinants of health, because the NHS cannot do this on its own, but can be active partners to
#BuildBackFairer
“Our health isn’t solely determined by medicine, doctors and genetics. Instead, sociological, economic and racial conditions have a greater impact on our wellbeing. What inevitably shapes these conditions is Power.”
#SureStart
had the biggest health impact in the poorest neighbourhoods.
Greater access to Sure Start can help close around half the gap in hospitalisations between rich and poor areas.
"How can I be a caricature of the out of touch, uncaring politician? I know: I'll blame the poor for their poverty" News for you: when the Elizabethan Poor Law was replaced by the workhouse in 1834, that was the rhetoric.
Clare
@ProfBambra
and I are unimpressed by further cuts to public health. A sorry history. Whenever the nation's health needs more attention the cuts get deeper
England has the largest excess mortality in Europe from 21 Feb to 12 June. I made the link to
#Marmot2020
where we showed that since 2010 UK had the slowest rise of life expectancy of any rich country except US and Iceland. Inequality plays an important role in both.
@MichaelMarmot
on
@Today
“Inequalities in mortality from Covid-19 parallel inequality in mortality from all causes suggests that the causes of inequalities in health overlap causes of inequalities in Covid 19”
#Marmot2020
Inequalities and Covid-19. On P5 of this Commentary, I spell out three consequences of structural racism in the US: police killings of black men, economic inequality, health inequality. Structural racism is harming BAME groups in the UK. Our police don't kill, but they do target.
Check out the latest edition of Commentary, now available online, as well as our specially commissioned cover (by artist
@Matt_Kettell
) celebrating the work of our frontline members and fellows.
📖